Operability in Bronchogenic Carcinoma

Abstract

To the Editor.— Numerous prognostic factors have been evaluated in bronchogenic carcinoma, and Dr Stoloff has now considered identification of tumor in a stem bronchus as a contraindication for surgical intervention (227:299, 1974). Thus far, tumor size, cell type, lymphovascular invasion, and node involvement have been shown to be important prognostic factors.1-6Indeed, node involvement is the basis of our present staging system.7We are not aware of other studies correlating precise anatomic endobronchial location with nodal involvement and survival. Exact differentiation between main stem and peripheral bronchial tumor involvement is often difficult bronchoscopically, especially when dealing with lesions at the upper lobe orifice and from information available in a retrospective series, such as Dr Stoloff's. Furthermore, if endobronchial location or distance from the carina proves to be prognostically important, one must remember the anatomic difference in length between the right (1 to 1.5 cm) and left (4